Effects of hypertonic saline, alternate day and daily rhDNase

[Guest guest]

And here is another article about a subject we talked about. Maia,

you asked about the difference if you use hypertonic saline instead

of Pulmozyme. It seems to be sufficient to use Pulmozyme only every

other day and alternate with hypertonic saline.

Peace

Torsten

Effects of hypertonic saline, alternate day and daily rhDNase on

healthcare use, costs and outcomes in children with cystic fibrosis

R Suri1,2, R Grieve3, C Normand3, C Metcalfe4, S 4, C Wallis2

and

A Bush1

1 Department of Respiratory Paediatrics, Royal Brompton and Harefield

NHS

Trust, London SW3 6NP, UK

2 Respiratory Unit, Great Ormond Street Hospital for Children NHS

Trust,

London WC1N 3JH, UK

3 London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK

4 Medical Research Council Biostatistics Unit, Institute of Public

Health, Cambridge CB2 2SR, UK

Correspondence to:

Dr R Suri, Department of Respiratory Paediatrics, Royal Brompton

Hospital, Sydney Street, London SW3 6NP, UK;

suriranjan@...

Background: Daily recombinant human deoxyribonuclease (rhDNase) is an

established but expensive treatment in cystic fibrosis (CF). An

alternative lower cost therapy is hypertonic saline (HS), which has

been

shown to improve lung function in short term studies. This study

compares

the costs and consequences of daily rhDNase with alternate day rhDNase

and HS in children with CF.

Methods: In an open, randomised, crossover trial, 48 children with CF

were allocated consecutively to 12 weeks of once daily 2.5 mg rhDNase,

alternate day 2.5 mg rhDNase, and twice daily 5 ml 7% HS. Outcomes

assessed included forced expiratory volume in 1 second (FEV1) and

quality

of life. All healthcare resource use was prospectively recorded for

each

patient. Unit costs were collected and combined with resource use

data to

give the total health service costs per patient for each treatment

strategy.

Results: Daily rhDNase resulted in a significantly greater increase in

mean FEV1 than HS (8%, 95% CI 2 to 14) but there was no significant

difference in FEV1 between daily and alternate day rhDNase (2%, 95%

CI -4

to 9). Over a 12 week period the mean incremental costs of daily

rhDNase

compared with HS was £1409 (95% CI £440 to £2318), and the incremental

cost of using daily rather than alternate day rhDNase was £513 (95% CI

-£546 to £1510).

Conclusions: Daily rhDNase is more effective than 5 ml 7% HS twice

daily

delivered by jet nebuliser, but significantly increases healthcare

costs.

Administering rhDNase on an alternate day rather than a daily basis

is as

effective, with a potential for cost savings.